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Interpreting Physician: CT (Revised 12-16-2022)

Revision History


All physicians who supervise and/or interpret CT examinations must be licensed medical practitioners who meet the following minimum criteria:


Requirements for all Physicians Supervising and/or Interpreting CT Examinations

Initial Qualifications

Board-Certified Radiologist

Non-Board Certified Radiologist

Other Physician

  • Board-certification in radiology or diagnostic radiology by the American Board of Radiology (ABR), American Osteopathic Board of Radiology (AOBR), Royal College of Physicians and Surgeons of Canada (RCPSC) or College des Medecins du Quebec (CMQ)

  • If board-certified before 2008 must also document supervision, interpretation and reporting of 300 CT examinations in the past 36 months

  • Radiologists graduating from residency after 6/30/14 must be board-certified or eligible as defined by the ABR

All of these:

  • Completion of an Accreditation Council for Graduate Medical Education (ACGME) or American Osteopathic Association (AOA) diagnostic radiology residency

  • Interpretation and reporting of 500 CT examinations in the past 36 months*

All of these:

  • Completion of an accredited specialty residency

  • 200 hours of category 1 CME in the interpretation of CT in the subspecialty where CT reading occurs

  • Interpretation and reporting of 500 supervised cases in the past 36 months

Continuing Experience

Upon renewal, physicians reading CT examinations must demonstrate one of the following:

  • Currently meets the Maintenance of Certification (MOC) requirements for the ABR or the Osteopathic Continuous Certification (OCC) for AOBR

  • Physicians reading CT examinations across multiple organ systems must have interpreted 200 CT exams over the prior 36 months

  • Physicians reading organ-system-specific exams (i.e. body, abdominal, musculoskeletal, head) across multiple modalities must interpret a minimum of 60 organ-system-specific CT exams in 36 months; however, they must interpret a total of 200 cross-sectional imaging (MRI, CT, PET/CT and ultrasound) studies over the prior 36 months (the 60 organ-system-specific exams are included in the 200 cross-sectional imaging studies)

Additional information regarding continuing experience requirements

Continuing Education

Upon renewal must meet one of the following:

Additional information regarding continuing education requirements


*Completion of an accredited radiology residency in the past 24 months will be presumed to be satisfactory for the reporting and interpreting requirements for both initial and continuing experience.


Occasional readers who are providing imaging services to and for the practice are not required to meet the interpreting physician initial qualifications or continuing experience requirements. However, the reads of all occasional readers combined should not exceed 5% of the total volume of reads per practice and per modality. There must be an active written review process in place at the institution for occasional readers based on each institution’s credentialing requirements. Validation of this process will take place during any site visit by the ACR.


Requirements for all Physicians Supervising and/or Interpreting Cardiac CT Examinations**

Initial Qualifications

Board-Certified Radiologist

Non-Board Certified Radiologist

Other Physician

  • Board-certification in radiology or diagnostic radiology by the American Board of Radiology (ABR), American Osteopathic Board of Radiology (AOBR), Royal College of Physicians and Surgeons of Canada (RSPSC) or College des Medecins du Quebec (CMQ)

  • If board-certified before 2008: supervision, interpretation and/or review and reporting of 75 Cardiac CT examinations within the last 36 months

  • Radiologists graduating from residency after 6/30/14 must be board-certified or eligible as defined by the ABR

  • Completion of at least 40 hours of category 1 Continuing Medical Education (CME) in cardiac imaging, including cardiac CT, anatomy, physiology and/or pathology, or documented equivalent supervised experience in a center actively performing cardiac CT

All of these:

  • Completion of an Accreditation Council for Graduate Medical Education (ACGME) Radiology Residency Program 

  • Have supervised interpretation of 75 cardiac CT cases in the past 36 months

  • Completion of at least 40 hours of category 1 Continuing Medical Education (CME) in cardiac imaging, including cardiac CT, anatomy, physiology and/or pathology, or documented equivalent supervised experience in a center actively performing cardiac CT

Cardiologists - Cardiac ONLY

Certification in cardiology by the American Board of Internal Medicine with completion of Level 2 training or higher


Level 2 Requirements (All of the following):

  • Board-certification or eligibility, valid medical license, and completion of a 3-month (cumulative) specialty residency or fellowship in Cardiac CT

  • 150 Cardiac CT examinations, including 50 where the candidate is physically present, involved in the acquisition and interpretation of the case 

  • Completion of 30 hours of courses related to CT in general and/or Cardiac CT in particular


Level 3 Requirements (All of the following):

  • Board-certification or eligibility, valid medical license, and completion of a 12-month (cumulative) specialty residency or fellowship in Cardiac CT

  • 300 Cardiac CT examinations, including 100 where the candidate is physically present, involved in the acquisition and interpretation of the case 

  • Completion of 60 hours of courses related to CT in general and/or Cardiac CT in particular


Nuclear Medicine Physicians - Cardiac ONLY


All of these:

  • Completion of an ACGME-approved training program in Nuclear Medicine

  • Interpretation and reporting under the supervision of a qualified physician of at least 75 cases of CT of the cardiovascular system during the past 36 months.

In addition:

  • Specific training in CT within an ACGME-accredited training program

OR

  • 160 hours of category 1 CME in CT, including, but not limited to: CT physics; recognition of artifacts; safety; instrumentation; and 40 hours specific to cardiovascular CT

Continuing Experience

  • Upon renewal, radiologists reading Cardiac CT examinations must have read 50 exams over the prior 24-month period. The cardiac exams interpreted will count toward the overall continuing experience for other CT modules.

  • Upon renewal, cardiologists reading Cardiac CT examinations must have continuing experience in accordance with level 2 requirements or higher - 50 examinations each year.

Additional information regarding continuing experience requirements

Continuing Education

  • Upon renewal, physicians must have earned at least 15 CME hours in CT (half of which must be category 1) in the prior 36 month period, and should include CME in Cardiac CT as is appropriate to the physician's practice needs.

  • Upon renewal, cardiologists must have completed at least 30 hours of coursework in the prior 36 month period, in accordance with Level 2 requirements.

Additional information regarding continuing education requirements


**Note: Reading calcium scoring CT exams does not count toward certification to interpret CCTA exams and reading calcium scoring exams does not require the CCTA certification. However, calcium score readers should understand there are cardiac-specific anatomy, quality-control, interpretation, and recommendation considerations that make relevant cardiac education/training beneficial.


In addition, all physicians interpreting CT examinations must:

  • Have completed an accredited diagnostic radiology residency or 80 hours of documented, relevant classroom instruction including diagnostic radiology and radiation safety physics. Otherwise, physicians must demonstrate training in the principles of radiation protection, the hazards of radiation exposure to both patients and radiological personnel, and appropriate monitoring requirements.

  • Be thoroughly acquainted with the many morphologic and pathophysiologic manifestations and artifacts demonstrated on computed tomography. Additionally, supervising physicians should have appropriate knowledge of alternative imaging methods.

  • Be knowledgeable of patient preparation, and training in the recognition/treatment of adverse effects of contrast materials for these studies, as described in the ACR-SPR Practice Parameter for the Use of Intravascular Contrast Media.  

  • Be responsible for reviewing all indications for the examination; specifying the use, dosage, and rate of administration of contrast agents (per the 2005 ACCF/AHA Clinical Competence Statement on Cardiac CT and MR, specifying the imaging technique, including appropriate windowing and leveling; interpreting images; generating written reports; and maintaining the quality of both the images and interpretations.

  • Be familiar with the meaning and importance to the practice of CT of: total radiation dose to the patient; exposure factors; conscious sedation principles that are performed in the practice; and post-processing techniques and image manipulation on work stations.


Regarding intravascular contrast media: 

The following providers may be considered capable of providing direct supervision1 of intravenous contrast material administration*, subject to applicable state and federal law:

  • A radiologist (MD/DO) 

Or – one of the following under the general supervision2 of a radiologist

  • Non-radiologist physicians (MD/DO)

  • Advanced practice provider (NP, PA)

  • Registered nurses following a symptom- and sign-driven treatment algorithm

*Note: supervision in this context only applies to administration of intravenous contrast media, not to the supervision of the radiologic examination or procedures.

 

This change would align radiology with the recognized skills of the aforementioned providers who are capable of managing acute hypersensitivity reactions to other drugs.


Responsible providers should be trained in, and periodically demonstrate competence in:

  • Managing acute hypersensitivity and physiologic drug reactions. This may be done using diagnostic decision-making, or by use of a symptom- and sign-driven treatment algorithm as commonly is used by nursing.

    • Appropriately administering reassurance, oxygen, antihistamine, intravenous fluids, beta2-agonist inhaler, epinephrine, position changes.

    • Understanding when to call for assistance and how to activate emergency response system(s).

    • Basic Life Support (BLS)

 

The provider of direct supervision must be immediately available to furnish assistance and direction throughout the performance of the procedure. This does not mean that the supervising provider or radiologist must be present in the room where and when the procedure is performed. However, there should be at least one person who can recognize adverse events related to contrast media administration in attendance (in the room or in an adjacent control room) to observe the patient during and immediately after the injection and summon medical assistance as needed. All local and state regulations regarding supervision of contrast media administration must be followed. 


1 “Direct supervision” means the definition specified at 42 CFR 410.32(b)(3)(ii), that is, the physician must be immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician or must be present in the room when the procedure is performed.

2 “General supervision” means the definition specified at 42 CFR 410.32(b)(3)(i), that is, the procedure or service is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure.


Revision History for this Article

Date

Section

Description of Revision(s)

12-12-19

All

Article created; FAQs incorporated; No criteria changes

4-6-2022

Requirements for all Physicians Supervising and/or Interpreting CT Examinations

Added or the Osteopathic Continuous Certification (OCC) for AOBR under Continuing Education and Experience

8-22-2022

Intravenous contrast media

Updated supervision of contrast administration requirement

12-16-2022

Intravenous contrast media

Updated supervision of contrast administration requirement

12-5-23


Corrected typo



Next: Radiologic Technologist: CT

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